Magnitude and factors associated with adherence to Iron-folic acid supplementation among pregnant women in Eritrean refugee camps, northern Ethiopia

Mixed-design institution-based cross-sectional study among pregnant Eritrean refugee women in four Shire refugee camps (Shimelba, May-Aini, Adi-Harush, Hitsats) in Northern Ethiopia. Quantitative component: 320 pregnant women; mean age 26.7 years (SD 5.95); majority 20–34 years. Qualitative component: six FGDs (56 participants) among pregnant women and three KIIs with midwives. Exclusion: critically ill. Data collected via structured interviews; analysis used logistic regression with GEE to adjust for camp effects.

Iron-folic acid tablets; dosage not specified; started around 17 weeks gestation; duration during pregnancy; taken daily (oral).

Adherence to iron-folic acid supplementation was 64.7% (95% CI 59.7%–70.0%). Independent predictors: lower knowledge about anemia (AOR 0.25; 95% CI 0.14–0.43); not receiving information about the importance of IFA (AOR 0.43; 95% CI 0.25–0.74); four or more ANC visits (AOR 2.83; 95% CI 1.46–5.48). Main non-adherence reasons: side effects (40%), unawareness of importance (30.2%), forgetfulness (14.4%), supply gaps (12.1%), fear of side effects (3.3%). Adherence is relatively low; strategies to improve adherence include counseling on IFA and anemia, ensuring information about its importance, promoting four or more ANC visits, and addressing forgetfulness and side effects; strengthen supply and ANC counseling and raise anemia awareness; adapt reminder strategies to daily routines rather than calendars given literacy considerations.

Self-reported adherence may overestimate true adherence; cross-sectional design limits causal inference; not all potential barriers to adherence were explored; knowledge assessment is subjective.